Dr Steve Graham on how to deal with TB in children
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(CNS): TB is a neglected disease, killing 1.5 million people each year. But perhaps the most neglected group of TB patients is the estimated 550,000 million children or more, who suffer from the disease each year. TB is commonly passed from adults to children and is among the top 10 causes of illness and death among children, killing more than 80,000 each year.
With a view to accelerate efforts to end childhood TB deaths, WHO had launched in October 2013, the first ever targeted Roadmap for Childhood TB that focussed upon key actions needed to tackle childhood TB. While speaking to Citizen News Service (CNS) at the 5th Asia Pacific Region Conference on Lung Health in Sydney, Dr Steve Graham, Professor of International Child Health at University of Melbourne and one of the main architects of this Roadmap, said that, "2015 is an exciting year for Childhood TB. The roadmap has drawn attention to this neglected problem and now more and more people are thinking about it. There is much more attention from national TB programmes (NTPs). We are close to getting innovations like fixed dose combinations for children that will be available soon. But more important is that the post 2015 End TB strategy of the WHO involves approaches that would include children--more community based and family based screening, preventive therapy, operational research, and working with other health sectors--particularly maternal and child health. We also have a Task force on Child TB that is bringing people from the maternal and child health sectors together to the NTPs to form child TB working groups at regional and national levels. Today there is a lot more to say on this issue than perhaps 5 years ago. So a lot of momentum has been built up and the roadmap is moving forward."
The road ahead
Access to diagnosis and care is a major challenge, feels Dr Graham. "The challenges that remain are that of correct diagnosis--too many people in the region do not have the confidence to make a correct diagnosis of TB in children. We still have the issue of trying to find TB in children diagnosed with pneumonia, in malnourished children. We definitely need better diagnostics. Better notification of child TB cases is also important. There are many more kids who have been diagnosed with TB but are never reported to the programme. And unless we have reliable data on how many kids have TB, we will not be able to plan out well for appropriate funding, evidence based advocacy, and appropriate interventions to deal with the problem. There has to be evidence based policy guidance and the political will and leadership to do so," said Dr Graham.
Currently there is a lack of effective diagnostic tests that can detect TB in children, as well as of child-friendly drug formulations for treatment and care for children with TB and/or those in contact of someone diagnosed with TB. Dr Cherise Scott, Director, Paediatric Programmes, TB Alliance (Global Alliance for TB Drug Development) emphasized upon the need for new tools to diagnose TB in children. All existing tests are sputum based and it is difficult for children to produce the sputum. Moreover they have less TB bacteria due to pauci-bacillary nature of the disease. So correct diagnosis becomes all the more difficult.
She said to CNS that, "Very often we have to depend upon clinical diagnosis and X-Rays, which are not confirmatory tests to detect TB. I think diagnostics for TB in children is even more neglected than treatment. We need new tools that do not rely on sputum. Use of GeneXpert has been recommended for diagnosing TB in children, but this tool is not available everywhere and moreover it is still sputum based. There is a lot of research going on to use other body fluids for diagnosis."
In a symposium at this conference, Dr Ben Marais, Associate Professor, The Children's Hospital at Westmead Clinical School and Deputy Director, Marie Bashir Institute for Infectious Diseases, shared some of the recent advances made for diagnosing TB in children. He was informed that there has been a growing interest in: